Over the years I have supervised a variety of staff, all of which were on telemetry units. Currently, I oversee 4-8 RN’s on a Cardiac Intensive Care Unit. These cardiac patients are here for a variety of reasons – ranging from heart transplant to post MI (heart attack) care and valve replacement to lethal rhythm (V-tach and Vfib) monitoring and management. All patients are monitored 24/7 on telemetry. Previously, I oversaw a staff of 8-10 RN’s working 12 hours shifts on a progressive care (ICU stepdown unit) cardiac unit housing 24-28 patients needing round the clock cardiac monitoring. Many of these patients were fresh out of angioplasty/PCI following a heart attack where they had stents placed or balloons were utilized to open vessels that led to the attack. This population depends greatly on close monitoring following these procedures to ensure new injury or re-occlusion does not occur. Familiarity with telemetry, cardiac rhythms, and general cardiac care is a must to manage a variety of conditions and potentially lethal outcomes. This particular unit monitored the telemetry/rhythms for the entire university system in the area in excess of 100 patients at any one time. Protocols and evidence-based practices are critical in guiding our practice, particularly with respect to the cardiac population needing constant ECG monitoring. An evidence-based approach to the care of this patient population is critical in protecting patients and the MD’s and facilities. System-wide protocols based on a national, research-based set of recommendations are vital to ensuring that current best practices are followed and that harm does not occur to this specific patient population.